Isometric system, method and apparatus

ABSTRACT

System, method and apparatus for carrying out isometric exercises for either diagnostic purposes or therapeutic purposes. When employed in a diagnostic mode, the instrument is programmed to carry out standardized diagnostic regimens and during such regimens provides both visual and aural cues, carries out mathematical computations of force values and provides recordation of diagnostic data in archival memory. When employed in a therapeutic mode the apparatus may only be programmed within mandated therapeutic parameter limitations. During therapeutic trials, the user is visually and aurally cued throughout the test sequence and the therapeutic data evolved during the regimen is recorded and recoverable from archival memory.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.10/268,363 filed Oct. 10, 2002, which claims priority of U.S.Provisional Application No. 60/330,265 filed Oct. 18, 2001.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH

The use of isometric as compared to rhythmic exercise in the generalfield of athletic strength development, as well as a therapy forstrength recovery has been the subject of somewhat controversialdiscourse over the past decades. In general, such exercise has beenconsidered to promote, for example, coronary risk factors. Seegenerally:

(1) Vecht R J, Graham G W S, Server P S. “Plasma NoradrenalineConcentrations During Isometric Exercise.” Brit Heart J. 1978;40:1216-20.

(2) Chrysant S G. “Hemodynamic Effects of Isometric Exercise inNormotensive Hypertensive Subjects”: Hypertension. Angiology1978:29(5):379-85.

However, as such attitudes persisted, some investigators commenced toobserve contradictions to these generally accepted beliefs. See for,example, the following publications:

(3) Buck, et al., “Isometric Occupational Exercise and the Incidence ofHypertension”, J. Occup. Med., 27:370-372, 1985.

(4) Choquette, et al., “Blood Pressure Reduction in ‘Borderline’Hypertensivies Following Physical Training” Can. Med. Assoc. J.1108:699-703, 1973.

(5) Clark, et al., “the Duration of Sustained Contractions of the HumanForearm of Different Muscle Temperatures”, J. Physiol., 143:454-473,1958.

(6) Gliders, et al., “Endurance Training and Blood Pressure inNormotensive and Hypertensive Adults”, Med. Sci. Sports Exerc.21:629-636, 1989.

(7) Hagberg, et al., “Effect of Weight Training on Blood Pressure andHemodynamics in Hypertensive Adolescents”, J. Pediatr. 1104:147-151,1984.

(8) Harris, et al., “Physiological Response to Circuit Weight Trainingin Borderline Hypertensive Subjects”, Med. Sci. Sports Exerc.,19:246-252, 1987.

(9) Hurley, et al., “Resistive Training Can Induce Coronary Risk FactorsWithout Altering VO_(2 max) or Percent Body Fat” Med. Sci. Sports Exerc.20:150-154, 1988.

(10) Hypertension Detection and Follow-Up Program Cooperative Group,“The Effect of Treatment on Mortality in ‘Mild’ Hypertension”, N. Engl.J. Med., 307:976-980, 1982.

(11) Kiveloff, et al., “Brief Maximal Isometric Exercise inHypertension”, J. Am. Geriatr. Socl, 9:1006-1012, 1971.

(12) Merideth et al., “Exercise Training Lowers Resting Renal but notCardiac Sympathetic Activity in Humans”, Hypertension, 18:575-582, 1991.

(13) Seals and Hagberg, “The Effect of Exercise Training on HumanHypertension: A Review”, Med. Sci. Sports Exerc., 16:207-215, 1984.

(14) Hanson P, Nagle F. “Isometric Exercise: Cardiovascular Responses inNormal and Cardiac Populations.” Cardiology Clinics 1987; 5(2):157-70.

Such speculation on the part of these early observers was confirmed byWiley in the 1990s, as described in U.S. Pat. No. 5,398,696 entitled“Isometric Exercise Method for Lowering Resting Blood Pressure and GripDynamometer Useful Therefore”, issued Mar. 21, 1995 and as described inthe following publication:

(15) Wiley, et al., “Isometric Exercise Training Lowers Resting BloodPressure”, Med. Sci. Sports Exerc. 29:749-754, 1992.

With the approach or protocol developed by Wiley, the isometric regimenis closely controlled both in terms of exerted force and in the timingof trials or exertions.

In contrast, earlier subjects or trainees undergoing isometric exercisestressed the involved musculature to their full or maximum capability(publication

(11)) or at some submaximal force as long as it could be sustained, ineither case only terminating with the onset of unendurable fatigue. Suchapproaches often have incurred somewhat deleterious results as evidencedby the injuries sustained in consequence of improper weightliftingprocedures. Weightlifting procedures or endeavors exhibit a significantisometric factor. See generally:

(16) Lind A R. “Cardiovascular Responses to Static Exercise”(Isometrics, Anyone?) Circulation 1970; 41(2): 173-176.

(17) Mitchell J H, Wildenthal K. “Static (Isometric) Exercise and theHeart: Physiological and Clinical Considerations”. Ann Rev Med 1974;25:369-81.

The diagnosis of patient hand-arm strength using isometric-based testinghas been employed by physiologists, physical therapists and medicalpersonnel for over three decades. These procedures function to evaluatehand-arm trauma or dysfunction and involve the patient use of ahandgrip-based dynamometer. The dynamometer is grasped by the patientand squeezed to a maximum capability under the verbal instruction of anattending therapist or diagnostician. The hand dynamometer most widelyused for these evaluations incorporates a grip serving to apply forcethrough closed circuit hydraulics to a force readout provided by ananalog meter facing outwardly so as to be practitioner readable.Adjustment of the size of the grip of the dynamometer is provided byinward or outward positioning of a forwardly disposed grip component.The dynamometers currently are marketed under the trade designation:“Jamar Hydraulic Hand Dynamometer” by Sammons Preston of Bolingbrook,Ill. An extended history of use of these dynamometers has resulted inwhat may be deemed a “standardization” of testing protocols. Forinstance, three of the above-noted grip length adjustments are employedin a standardized approach and verbal instructions on the part of thetesting attendant, as well as the treatment of force data read from theanalog meter are now matters of accepted protocol. In the latter regard,multiple maximum strength values are recorded, whereupon averagestrengths, standard deviations and coefficients of variation arecomputed by the practitioner. In one test, the instrument is alternatelypassed between the patient's right and left hands to derive a maximumstrength output reading each 1.5 seconds or 2.5 seconds. Reading andhand recording strength values for such protocols has remainedproblematic. The protocols, for example, have been the subject ofrecommendations by the American Society of Hand Therapist (ASHT) andhave been discussed in a variety of publications including thefollowing:

(18) Mathiowetz V., Federman S., Wiemer D. “Grip and Pinch Strength:Norms for 6 to 19 Year Olds.” The American Journal of OccupationalTherapy 40:705-11, 1986.

(19) Mathiowetz V., Donohoe L., Renells C. “Effect of Elbow Position onGrip and Key Pinch Strength.” The Journal of Hand Surgery 10A:694-7,1985.

(20) Mathiowetz V., Dove M., Kashman N., Rogers S., Volland G., Weber K.“Grip and Pinch Strength: Normative Data for Adults.” Arch Phys MedRehabilitation 66:69-72, 1985.

(21) Mathiowetz V., Volland G., Kashman N., “Reliability and Validity ofGrip and Pinch Strength Evaluations.” The Journal of Hand Surgery9A:22-6, 1984.

In about 1998, the above-noted Wiley protocols as described inconnection with publication (12) above were incorporated in a compact,lightweight isometric device. Described in detail in U.S. Pat. No.5,904,639 entitled “Apparatus, System, and Method for Carrying OutProtocol-Based Isometric Exercise Regimens” by Smyser, et al., thehand-held dynamometer has a hand grip which incorporates a load cellassembly. Extending from the hand grip is a liquid crystal display andtwo user actuated control switches or switch buttons. The display ismounted in sloping fashion with respect to the grip such that the usercan observe important visual cues or prompts while carrying out acontrolled exercise regimen specifically structured in terms of forcevalues and timing in accordance with the Wiley protocols. This device istherapeutic as opposed to diagnostic in nature and is microprocessordriven with archival memory. External communication with the batterypowered instrument is made available through a communications port suchthat the device may be configured by programming and, additional data,such as blood pressure values and the like may be inserted into itsmemory from an external device. Visual and audible cueing not onlyguides the user through a multi-step protocol but also aids the user inmaintaining pre-computed target level grip compression levels.

Of course, it will be beneficial to incorporate improved diagnosticfeatures for hand-arm evaluation techniques with therapist orpractitioner designed therapeutic protocols specifically tailored to thecondition of a given patient and which provide a control over suchtherapies clearly establishing such therapies as beneficial to strengthdevelopment and recovery.

BRIEF SUMMARY OF THE INVENTION

The present invention is addressed to a system method and apparatus forcarrying out a controlled isometric regimen by a user. Beingmicroprocessor driven, the instrument is programmed to carry outestablished diagnostic as well as newly developed grip-based isometricregimens. When carrying out diagnostic procedures, the attendingdiagnostician may elect either a maximum grip test or a rapid exchangetesting procedure. When employed for carrying out a diagnostic maximumgrip test, the diagnostician selects configuration parameters and theinstrument provides both visual and audible prompts and cues throughoutthe procedure. Maximum grip forces for each of the sequence of trials ofthis procedure are selected typically by the diagnostician and when soselected are recorded in instrument memory along with calendar data, andprocessor computed values for average grip force, standard deviation ofthe force values throughout a sequence of tests and correspondingcoefficients of variation. At the termination of the diagnosticprocedure, memory recorded test data are displayable to thediagnostician and may be downloaded through a communications port to acomputer facility.

When utilized in a rapid exchange test mode, the attending diagnosticianagain programs the instrument with elected but standardized testparameters. At the commencement of and during the ensuing multi-trialtest procedure, the patient may be provided with aural cues and, at theelection of the diagnostician with visual cues. Grip force values foreach trial are recorded in memory. As before, the instrument processoraccesses that memory retained data and computes average grip forcevalues, corresponding standard deviation for those force values andcoefficient of variation, the values of which also are recorded inmemory. At the termination of the multi-trial test regimen, thediagnostician is provided a successive display of the force values andassociated computed information recorded in instrument memory.

For each of the diagnostic procedures, the widthwise extent of theinstrument grip may be both varied in standard ½ inch increments from aminimum width. The grip is further configured such that the visuallyperceptible readout of the instrument may be viewed only by thediagnostician where deemed appropriate.

An important aspect of the therapeutic method associated with theinstrument of the invention resides in the limiting of user performanceto carry out the regimen of trials. In this regard, the instrument isprogrammed to perform only within predetermined and mandated testlimits. Two therapeutic methods are described, a fixed therapy and astepped therapy. Each therapeutic regimen is based upon an initialevaluation of the maximum gripping force capability of the user. Underthat limitation, target load factors, hold on target load intervals,intervening rest intervals and trial repetition numbers may be electedonly from pre-established and mandated memory retained ranges. Theprogram also nominates rest intervals and hold on target intervals incorrespondence with user elected target force factors. Thus, valuablestrength recovery and development may be achieved but only within safelimits.

During each of the above therapeutic regimens, an audible warning iselicited whenever the user grip force value exceeds a computed upperlimit. During each timed interval wherein the user is prompted to gripat a target force value computed with respect to the pre-tested maximumgrip force, a dynamic bar graph and center point display is provided asa visual cue related to desired grip performance. Additionally, a rapidsuccession of score values are computed and the average thereof recordedat the end of each trial of a given regimen. These scores permit atherapist to access the quality of the performance of the user. Ingeneral, trial data is recorded in conjunction with calendar data and,as before, may be downloaded to a computer facility from an instrumentcontained communications port.

Other objects of the invention will, in part, be obvious and will, inpart, appear hereinafter.

The invention, accordingly, comprises the method, system and apparatuspossessing the construction, combination of elements, arrangement ofparts and steps which are exemplified in the following detaileddescription.

For a fuller understanding of the nature and objects of the invention,reference should be made to the following detailed description taken inconnection with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of apparatus according to the inventionshowing its orientation with respect to a users hand wherein its displayis viewable by such user;

FIG. 2 is a perspective view of the apparatus of FIG. 1 showing theorientation of the apparatus with respect to the users hand wherein thedisplay thereof is not visually accessible to the user;

FIG. 3 is an exploded perspective view of the apparatus of FIG. 1;

FIG. 4 is a side sectional view of the apparatus of FIG. 1;

FIG. 5 is a side view of the apparatus of FIG. 1 showing a minimum gripwidth configuration;

FIG. 6 is a side view of the apparatus of FIG. 1 showing an orientationfor user viewing of its display and a grip widthwise extent ½ inchgreater than the grip orientation of FIG. 5;

FIG. 7 is a side view of the instrument of FIG. 1 showing an orientationfor user viewing of its display and illustrating a grip widthwise extentof maximum value;

FIG. 8 is a side view of the instrument of FIG. 1 showing an orientationfor diagnostic viewing and a grip widthwise extent corresponding withthat of FIG. 6;

FIG. 9 is a side view of instrument of FIG. 1 showing a displayorientation for viewing of a display by a diagnostician and having agrip widthwise extent corresponding with that of FIG. 7;

FIG. 10 is a block diagrammatic drawing of the circuit employed with theapparatus of FIG. 1;

FIG. 11 is a flow chart describing the start up components of theprogram of the instrument of FIG. 1 as well as a configuration routine;

FIGS. 12A and 12B combine as labeled thereon to provide a flow chart ofa maximum grip test diagnostic procedure;

FIG. 13 is a flow chart illustrating a rapid exchange diagnosticprocedure;

FIGS. 14A-14C combine as labeled thereon to illustrate a flow chartdescribing a therapeutic fixed exercise regimen carried out by theinstrument of FIG. 1;

FIG. 15 is a flow chart demonstrating the technique by which a scorevalue is developed by the apparatus of the invention;

FIGS. 16A-16E are a sequence of displays provided by the instrument ofthe invention showing a publication of score, a dynamic bar graph withcenter pointer and a time remaining cue;

FIGS. 17A-17C combine as labeled thereon to illustrate a flow chart of astep therapeutic exercise which may be carried out with the instrumentof the invention;

FIG. 18 is a flow chart showing an intentional power off sequence; and

FIG. 19 is a flow chart describing the applicability of the use ofisometric exercise in conjunction with safe muscle strengthening andtherapy protocols for a broad range of muscle groups.

DETAILED DESCRIPTION OF THE INVENTION

Isometric exercise apparatus under which the methodology of theinvention may be carried out is lightweight, portable, battery poweredand sufficiently rugged to withstand the compressive pressures which itnecessarily endures during use. The instrument is programmable such thatit may be utilized by a therapeutic practitioner for diagnostic purposesemploying established grip test modalities. Strength measurementscarried out during these modes are compiled in memory and thepractitioner is afforded calculated values for average grip force,standard deviation and coefficient of variation with respect to gripforce trials. Furthermore, individual strength measurements compiled inthese averages, whether taken rapidly or slowly, are stored in memoryand may be reviewed by the therapist.

Additionally, the instrument is employable as a therapeutic device.First a protocol is nominated by prescribing nominal parameters of theeffort. Each isometric regimen is controlled initially by requiring thata maximum grip strength be established for each individual patient oruser. Then, the practitioner may elect parameters of grip force andtiming under mandated memory contained parameter limits. Accordingly,the user will be unable to carry out strength enhancement therapieswhich would otherwise constitute an excessive grip force regimen. Forcarrying out the noted diagnostic procedures as well as therapyactivities, the grip widthwise extent is variable from 1⅞ inches to 2⅞inches, such variation being adjustable in ½ inch increments. This is inkeeping with standardized diagnostic practices. Further with respect todiagnostic procedures, the display or readout of the instrument can beadjusted with respect to the grip structuring such that only thepractitioner or therapist may observe the data which is being developedduring a diagnostic protocol.

Looking to FIG. 1, the instrument or apparatus is represented generallyat 10 as having a housing identified generally at 12. Housing 12 isformed of acrylonitrile butadiene styrene (ABS) and, thus, is resistantto impact phenomena and the like. FIG. 1 shows that the housing 12includes a hand grasping portion 14 and an integrally formed interactingportion 16. Interacting portion 16 supports a readout assembly 18 whichis configured as an elongate liquid crystal display (LCD). Additionallylocated at the interacting portion are two finger actuable switchesrepresented generally at 20. Of these switches, switch 22 is designatedas a “menu” switch, while switch 24 is designated as a “select” switch.Note that the readout assembly 18 is angularly oriented with respect tothe grip axis 26 of the apparatus 10. With this configuration, the usermay observe prompts and cues appearing at the readout 18 as representedby the symbolic user eye station 28 and line of sight representedsymbolically at arrow 30. In this regard, note that the hand 32 of theuser is grasping the hand grasping portion 14. For the arrangementshown, the hand grasping portion 14 is represented as exhibiting itslargest widthwise extent, i.e., 2⅞ inches. To gain this larger widthwiseextent, auxiliary grip components 34 and 36 are employed in conjunctionwith the hand grasping portion 14. These auxiliary grip components willbe seen to be removable as well as universally positionable so as toprovide the noted widthwise adjustments in ½ inch increments.

Referring to FIG. 2, the instrument 10 is shown as it is employed fordiagnostic activities. For this purpose, the auxiliary grip components34 and 36 as seen in FIG. 1 have been reversed in their orientation athand grasping portion 14. Note, additionally, that the symbolic eyestation at 38 is now that of the diagnostician with a line of sight asrepresented symbolically at arrow 40 addressing the readout 18 (notshown). Note that the line of sight 40 is directed toward the auxiliarygrip component 36 and the data readout for diagnostic purposes is notvisually available to the user whose hand is represented at 32. Seenadditionally in FIG. 2 is a serial communications port 40 and a batterycompartment access cover 42. This serial port offers, for diagnosticpurposes, the instantaneous transfer of real-time data to remotemonitoring and data archiving equipment.

Looking to FIG. 3, an exploded perspective view of the apparatus 10 isprovided. In the figure, the grasping portion 14 is seen to be comprisedof two mirror image sides 52 and 54. Integrally molded with the sides 52and 54 are the two housing components of the interactive portion 16 asshown respectively at 56 and 58. Plastic inserts or plugs are shown at60 and 62 which are insertable within respective screw cavities 64 and66. Extending from grasping portion side 54 is an integrally moldedscrew receiving post 68. In similar fashion, screw receiving post 70 isintegrally formed with and extends from component 58. Additionally, ascrew receiving post 72 extends from component 58. Post 72 receives ascrew inserted through a battery cavity 74 inwardly disposed from cover42. Post 72 additionally functions to contribute to the support of aprinted circuit board 76 by virtue of its insertion through an aperture78 formed therein. Note that the printed circuit carrying board 76 alsosupports communications port 40. In this regard, the port 40 extendsinto a rectangular opening 80 formed within interactive portion 58 ofhousing 12. Further extending inwardly from component 52 are two forceplate support plates 53 and 55

Disposed centrally within the cavity defined by gripping portion sides52 and 54 is a steel thrust plate 82 having a thickness and rigidityelected to withstand compressive gripping forces which may range, forexample, up to about 205 pounds. Plate 82 is configured with two holes81 and 83 which are used to restrain the plate from disengaging from theassembly when fitted over respective posts 53 and 55. Elongate side 84of thrust plate 82 is configured for insertion within an elongate groove86 of a base grip component 88. Grip component 88 is formed of a rigidplastic and includes an outwardly disposed base grasping surface 90upwardly located in adjacency with the grasping surface 90 is onecomponent of a base connector assembly represented generally at 92 andwhich is seen to be integrally molded with the grip component 88 andincorporates a slot or opening 94 in conjunction with a tab receivingtrough 96. A tab component (not shown) of the base connector assemblyfeature of the base grip component 88 will be seen to extend from theend thereof opposite connector assembly component 92.

Two oppositely disposed edge extensions 98 and 100 of the thrust plate82 are configured for operative association with a load cell assemblyrepresented generally at 102. Load cell assembly 102 includes anelongate steel base 104 incorporating two slots for receiving extensions98 and 100, one such slot being revealed at 106. Connection between thebase 104 and thrust plate 82 is provided by pins (not shown) whichextend through mated bores 108 and 110 and 112 and 114. The load cellassembly 102 further includes an elongate outer force component 116. Twofield plate-form load cells 118 and 120 are mounted from load cell mountstructures shown, respectively at 122 and 124 formed within base 104.Such mounting is in cantilever fashion, the load cell 118 being attachedto mount 122 by a screw and mounting plate assembly 126. Similarly, loadcell 120 is attached in cantilever fashion to mount structure 124 by ascrew and mounting plate assembly 128. Outer force component 116 is seento have a centrally disposed rectangular post portion 130 which isattached by a connector plate assembly to the mutually inwardlyextending ends of the load cells 118 and 120. The attachment plateassembly for this union is seen in general at 132. Assembly 132 is seento be formed of two plate components 132 a and 132 b coupled, in turn,to load cells 120 and 118. Screws are use to effect the attachment.

The base grip component positioned oppositely of base grip component 88is shown at 134. In similar fashion as component 88, the base gripcomponent 134 is configured with a base connector assembly having onecomponent at 136 which incorporates a slot and trough (not shown) insimilar fashion as described at 92 in connection with component 88. Atab protrusion of generally cylindrical configuration shown at 138 isdisposed oppositely from connector assembly component 136. The rigidplastic base component 134 is attached to elongate outer force component116 of the load cell assembly 102. This attachment is provided by theinsertion and crimping of two posts 134 a and 134 b (FIG. 4) withinrespective holes 117 and 119 formed within force component 116. A slotin component 1134 is provided to positively locate it onto the outerprofile of component 116. In general, posts 134 a and 134 b (FIG. 4) areinserted through holes 117 and 119 and then melted with a hot iron tomechanically secure the two pieces 134 and 116 together as onesub-assembly. With the arrangement shown, gripping compressive force isasserted from the base component 188 through the thrust plate 82 intothe load cell assembly 102. This force is counteracted by gripping forceasserted from base gripping component 134.

Auxiliary grip component 34 is shown in the figure in spaced adjacencywith respect to the base grip component 134. Auxiliary component 34 isconfigured with an outwardly disposed auxiliary grasping surface ofgenerally half cylindrical cross section with a grasping surface profilecurved concavely outwardly, for example, at region 140. This curvatureis provided for enhancing grip contact with the palm of the user handand for applying force centrally to the load cell assembly. Component 34is formed with an auxiliary connector assembly which includes a flexibleengaging tab 150 configured for insertion within the connector component136 of base grip component 134. Connection at the opposite end isprovided by a curved slot (not shown) which receives the tab protrusion138 of base grip component 134. The connector assemblies are universalsuch that each of the auxiliary grip components may be mounted uponeither of the base grip components 88 or 134. In this regard, not that asimilar flexible engaging tab 152 is positioned upwardly upon auxiliarygrip component 36. Similarly, the component 36 is configured having acurved slot 154 at its opposite end which receives tabs, for example, asat 138. The mounting of either auxiliary grip component 36 or 34 willincrease the widthwise extent of the grip by one half inch. Accordingly,with both auxiliary grip components installed, the widthwise extent ofthe grip is increased to 2⅞ inches.

Interacting region 16 also includes a top cover 156. Formed, as theother components, of ABS plastic, the cover 156 includes a rectangularbezel opening 158 within which the LCD 18 is positioned. Integrallyformed with top cover 156 is a downwardly depending switch cover 160through which two rectangular openings 162 and 164 are provided. Theswitching function 20 is mounted upon a separate circuit board 166 whichis seen to carry two push actuated switches as earlier described at 22and 24 and identified by the same numeration in the instant figure.Located over the switches 22 and 24 is a flexible polymeric cover 168formed of a flexible polymeric material such as Santoprene, athermoplastic elastomer marketed by General Polymers of Charlotte, N.C.Circuit board 166 is supported between two slots formed in the interiorof side components 56 and 58, one of these slots is seen at 170. The LCD18 is mounted upon a circuit board 172 supported in turn, frominteractive components 56 and 58. A bus-type wiring harness electricallyassociates the switching function 20, LCD 18, load cell assembly 102,the battery within compartment 74 and the circuitry carried by circuitboard 76.

A sectional view of the instrument 10 is provided at FIG. 4. In thefigure, base grip component 88 is shown in conjunction with baseconnector assembly component 92. In that regard, the slot 94 again isrevealed as well as the tab receiving trough 96. At the opposite end,the base connector assembly includes an outwardly extending arcuate tab174. Auxiliary gripping component 36 is shown coupled to the base grip88. Note that the auxiliary component 36 has a grasping surface 176, theprofile of which is undulatory to provide a finger graspingconfiguration. This undulatory profile further functions to provide afinger grasping configuration which centers the gripping force on handle88. The lower portion of the base grip component 88 is seen to be formedhaving an outwardly extending arcuate tab 174 which slideably nestswithin the corresponding arcuate slot 154 in auxiliary grip 36. Theconnector assembly for base grip component 134 is identical. In thisregard, the component 134 includes an arcuate outwardly extending tab138 and a slotted receiver 136 structured identically as that describedat 92. Auxiliary grip component 34 is connected to base grip component134 by sliding a protruding tab or tongue 138 into arcuate slot 178.Additionally, the flexible engaging tab 150 is shown extending through aslot in connector component 136.

FIGS. 5-7 illustrate variations of grip widthwise extent available forutilization of instrument 10 in conjunction with therapeutic protocols.In general, for such therapeutic protocols, the readout assembly 18 isarranged to face the eye station of the user. In FIG. 5, no auxiliarygrip components are mounted upon either base grip component 88 or basegrip component 134. Accordingly, the widthwise extent of the grip is 1⅞inch. Looking to FIG. 6, the palm engaging auxiliary grip component 34is shown mounted over base grip component 134. This increases thewidthwise extent of the grip for therapeutic applications to 2⅜ inches.FIG. 7 illustrates the utilization of both auxiliary grip components 34and 36 to provide a grip widthwise extent of 2⅞ inches. As before, theauxiliary grip components are arranged such that the user may observereadout 18.

FIGS. 8 and 9 illustrate grip arrangements particularly suited fordiagnostic purposes wherein the diagnostician has exclusive accessvisual to the readout assembly 18. In FIG. 8, base grip component 134 iscombined with auxiliary grip component 34 to provide a widthwise gripextent of 2⅜ inches. Removal of the auxiliary grip component 34 returnsthe grip widthwise extent to 1⅞ inches.

In FIG. 9, both auxiliary grip components 34 and 36 are employed toprovide a maximum widthwise grip extent of 2⅞ inches. It may be observedin FIGS. 8 and 9 that the positioning of the auxiliary grips is reversedin the sense of the grip configuration shown in FIGS. 5-7.

Turning to FIG. 10, a block diagrammatic representation of thecontroller components of instrument 10 is revealed. In general, theinstrument 10 is microprocessor driven, for example, employing a type8051 microprocessor as represented at block 180. The controller ispowered by a standard 9 volt battery. That voltage then is regulated to5 volts for use by the circuit components. A power supply to the straingauge implemented load cells 118 and 120 is dropped by a resistor suchthat the maximum current applied is limited to 50 milliamps. Such powersupply is represented in the figure at block 182 which, in turn, is seento be associated with microprocessor 180 via line 184 and with switch 24via lines 186 and 188. Note that switches 22 and 24 respectively arelabeled “menu” and “select”. Switch 24 serves the additional function ofan on switch or enablement switch. Power also is seen to be supplied tothe communications connector 40 as represented at line 190.Communications connector 40, in turn, is seen coupled to acommunications driver 192 as represented at line 194. Driver 192associated with the microprocessor 180 as represented at line 196. Themicroprocessor 180 also provides control over an annunciator or buzzeras represented at block 198 and line 200. Similarly, control to theliquid crystal display (LCD) 18 from microprocessor 180 is representedat line 202. A real-time clock is provided with the controller circuitas represented at block 204. Time and date data from that clock are usedin conjunction with the monitoring and memory features of the instrument10 such that important data, including date and time of a given trialregimen can be retained in memory and downloaded via the communicationsport 40 when called for. The association of the real-time clock function204 and microprocessor 180 is represented at line 206. Archival memoryas well as temporary memory are provided with the controller. Archivalmemory may be provided, for example, as an electrically erasableprogrammable read only memory (EE PROM), an 8 kilobyte device whichrequires no power to sustain its memory retention, i.e., it isnon-volatile. The archival memory is represented at block 208 and itsassociation with the microprocessor 180 is represented at line 210.

Load cells 118 and 120 are represented with that numeration in FIG. 10.These load cells are each configured as a four resistance balancebridge-type load cell. The outputs of load cells 118 and 120 aredirected to an amplification function as represented by respective lines212 and 214 extending to amplifier block 216. The output of amplifier216 is represented at line 218 extending to an analog-to-digitalconverter function represented at block 220. Correspondingly, output ofthe converter function 220 is directed to the microprocessor 180 asrepresented at line 222. Microprocessor 180 converts the signal to aforce value in pounds or kilograms which is displayed in the LCD 18. Themenu switch 22 is shown associated with microprocessor 180 via line 224,while the select switch 24 is associated with that processing functionas represented at line 188.

Each of the instruments 10 is calibrated using nineteen combinations ofsix standard weights. A best fit is determined and the instrument iscalled upon to have a root mean square error (RMS) of 0.1 pounds or lessto pass calibration requirements. Once the calibration constants hasbeen determined, the system is loaded with two redundant copies of thecalibration constants. The zero point of the load cell is monitored atall times during the use of the instrument 10. If a drift is found, thena warning is shown at the LCD display 18. If any lead wire to the loadcell becomes disconnected, then the built-in monitoring detects thisoccurrence, shows an error message, and disables further use ofinstrument 10 until the power is reset. These features insure that theforce reading shown is accurate and true. Absolute values of the outputsof load cells 118 and 120 are summed to provide a force output signal.In general, the load measurement accuracy of instrument 10 is betterthan 0.1 pound or 0.1% of applied force whichever is greater.

In the discourse to follow, the sequences of the program protocolcarried out by instrument 10 are represented in flow chart fashion. Ingeneral, these flow charts commence with a configuration sequence ifdesired and then look to two diagnostic protocols followed by twotherapeutic protocols.

Turning to FIG. 11, the procedure seen to commence as represented atblock 230 with the selection of the grip widthwise extent. In general,that grip width is elected to accommodate variations in user hand sizes.The program then continues as represented at line 232 and block 234wherein, where appropriate, one or two auxiliary grip components as at34 and 36 are installed in an orientation providing for user viewing ofdisplay 18 as illustrated in connection with FIG. 1, or in anarrangement for therapeutic practitioner viewing to the exclusion of theuser as described in connection with FIG. 2. The program then continuesas represented at line 236 and block 238 providing for the enablement ofinstrument 10 by actuation of select switch 24. Upon such actuation, asrepresented at line 240 and block 242 a start-up message is provided atdisplay assembly 18 for an interval of two seconds. Then, as representedat line 244 and block 246 a prompt is displayed at readout 18identifying a default configuration wherein pounds as opposed tokilograms are elected; an audible tone is enabled, and for a diagnostictest referred to as “rapid exchange” wherein instrument 10 is passedfrom one hand of the user to the other and then back for a number ofexchanges, the user providing a grip force trial at each exchange. Therapid exchange default values are ten exchanges with 1.5 secondsavailable for user griping or squeezing. Following the publication ofthe screen as represented at block 246, should the user not actuateeither the switches 22 or 24, then as represented at line 248 and block250 the instrument 10 will turn off or power down at the end of a fiveminute interval. This feature is always active, i.e., turning off fiveminutes after a last switch actuation.

With the publication of the screen as represented at block 246, then asrepresented at line 252 and block 254 the practitioner or user is calledupon to determine whether to enter a configuration sequence or toprogress to a diagnostic grip test. To enter the latter diagnostic griptest sequence, as represented at line 256 and block 258 by pressingswitch 24 display 18 will prompt the user to press the select switch 24to commence a diagnostic grip test sequence. Where the select switch 24is actuated, then the program enters the diagnostic grip test sequenceas represented at line 260 and node A.

Where a determination on the part of the practitioner or user is made toenter a configuration sequence, then as represented at line 262 andblock 264 the configuration sequence is entered by actuating switch 22.As represented at line 266 and block 268 the initial configuration looksto units. Recall from block 246 that the instrument 10 defaults to aunits evaluated in pounds. As represented at line 270 and block 272 byactuating select switch 24 the units parameter can be converted tokilograms instead of pounds. The program then continues upon depressingor actuating menu switch 22 as represented at either lines 274 or 276leading to block 278. As represented at block 278, the user then isgiven the opportunity to delete the audible tone. In this regard, byactuating select switch 24, as represented at line 280 and block 282,the tone is deleted, display 18 showing the term “tone” in connectionwith the letter N.

The configuration sequence then continues as represented at either lines283 or 284 with the actuation of menu switch 22. This actuation ofswitch 22 provides for the establishing of a rapid exchange diagnostictest cycle time change. As set forth at block 286 the default cycle timeis 1.5 seconds. However, by actuation of select switch 24, asrepresented at line 288 and block 290 the operator may change the cycletime to 2.5 seconds. The program then continues by actuating the menuswitch 22 as represented at either of lines 292 or 294. These lines leadto the configuration alteration represented at block 296. Recall fromblock 246 that the default number of exchanges for the rapid exchangediagnostic procedure is 10. However, as represented at line 298 andblock 300 the operator may change the number of exchanges from 10 to 20by actuation of select switch 24. The program then returns to line 244by actuation of the menu switch 22 as represented at lines 302 and 304.As described in connection with block 258, line 260 and node A, theoperator may elect to proceed with a diagnostic grip test.

Referring to FIG. 12A, node A reappears in conjunction with line 306extending to the query posed at block 308 wherein a determination ismade as to whether or not to enter a diagnostic grip test mode. Wherethe operator determines that the diagnostic grip test mode should beentered, then as represented at line 310 and block 312, the grip testmode is entered by actuating select switch 24. The operator is thenprompted at display 18 to actuate select switch 24 to enter a max testmode. Accordingly, with the actuation of switch 24, as represented atline 314 and block 316 the maximum diagnostic grip test mode is entered.On the other hand, as represented at line 318 and node B by actuatingthe menu switch 22, the practitioner may cause instrument 10 to enter arapid exchange sequence.

Returning to block 316, the maximum strength grip test can be carriedout with 10 maximum squeezing force trials. At the conclusion of a givennumber of such trials, the practitioner actuates select switch 24,whereupon computations are carried out. Accordingly, as represented atline 320 and block 322 the user is prompted with the message “squeezehard!!!” at the readout 18. The program will elect the highest forceapplied during such squeezing activity, whereupon the user releases thegrip force as represented at line 324 and block 326. Then instrument 10will publish the maximum force applied by the user as represented atline 328 and block 330, a first maximum grip evaluation being shown asan example as 64.4 pounds. Block 330 also indicates that the user isprompted to either actuate the select switch 24 to accept the publishedmaximum squeeze evaluation as set forth at block 330 or to squeeze thegrip 14 again. Such squeezing again will provide a substitute maximumgrip force evaluation. Then, as represented at line 332 and block 334the query is posed as to whether the select switch 24 has been actuated.In the event that it has not, then the program loops as represented atline 336 extending to line 320, whereupon a maximum grip effort again isundertaken. Where the operator elects the maximum first trial grip forceevaluation, then as represented at line 338 and block 340, the programwill compute an average of force values, standard deviation andcoefficient variation, albeit it for one trial at this juncture in theprocedure.

The program then continues as represented at line 342 and block 344 todisplay computed values which, as noted above, for the first trial areirrelevant. However, as the number of trials increases, those computedvalues gain significance. Next, as represented at line 346 and block 348the program commences to carry out a next maximum grip test by providinga prompt at readout 18 which advises the user to “squeeze hard!!!” andindicates that this is a second trial as represented by the terms: “MAX2”. Following a squeezing of the grip region 14, as represented at line350 and block 352 the user releases the grip force and, as representedat line 354 and block 356 the maximum force asserted by the user ispublished, for example, showing 60 pounds for a “MAX 2” trial. Thisprompt further advises the user to actuate select switch 24 to elect thepublished grip force value or to squeeze again to carry out a nexttrial. The program then continues as represented at line 360 and block362 to determine whether or not select switch 24 had been actuated. Inthe event that it had not been actuated then the program loops asrepresented at lines 364 and 346 whereupon the user again may carry outthe second maximum grip trial. Where switch 24 has been actuated, thenas represented at line 366 and block 368, the program carries out acomputation of the average of the maximum forces asserted and computesstandard deviation and coefficient of variation which are submitted tomemory. The program then continues as represented at line 370 and block372 whereupon the values computed in connection with block 368 arepublished at display 18. The above maximum grip test trials may bereiterated for 10 trials. Accordingly, as represented at line 374 andblock 376 the maximum test trials are reiterated for a total of N tests(10 maximum) and the computed values of average force, standarddeviation and coefficient of variation are both submitted to memory andpublished at display 18. As represented at line 378 and block 380 theuser may restart this max test sequence following the Nth trial byactuating select switch 24, whereupon the program returns as representedat line 382 to line 310 (FIG. 12A). Returning to block 380, by actuatingmenu switch 22, as represented at line 384 and block 386, a subsequentactuation of select switch 24 will return the program to a previousmenu. As represented at line 388 and block 390 by again actuating menuswitch 22, as represented at line 392 the program reverts to node B asdescribed in conjunction with FIG. 12A. By again actuating select switch24, as represented at line 394 the program returns to entry into themaximum grip diagnostic test, line 394 extending to line 314 seen inFIG. 12A. This circular logic is made available at a variety oflocations within the program.

Returning to FIG. 12A, where the query posed at block 308 results in anegative determination that the maximum grip test diagnostic mode is notto be entered, then, by actuation of menu switch 22, as represented atline 396 and block 398 a determination is made as to whether to exit adiagnostic mode and enter a therapy based mode. Where a therapy mode isnot elected, then as represented at line 400 and block 402 a previousmenu may be elected by actuating the select switch 24 as represented atline 404 and node D. By actuating menu switch 22, then as represented atline 406, the program loops to line 306 and the query posed at block308. Where a therapy mode is elected by the user, then as represented atline 408, the program diverts to a therapy mode of performance asrepresented at line 408 and node E.

Looking back to the query posed at block 334, where the menu switch 22is actuated as opposed to electing a maximum grip value, then asrepresented at line 410 and block 412 the program will reconfigure forrestarting the grip test mode. Once at this point in the program asrepresented at block 412, by again actuating select switch 24, theprogram reverts, as represented at line 414 to line 320 to carry outanother maximum grip trial. On the other hand, where menu switch 22 isactuated, as represented at line 416 and block 418 an indication will begiven to the operator that to elect a previous menu, select switch 24 isto be actuated. As represented at line 419, the program then reverts tonode C. Node C again appears in FIG. 12A in conjunction with line 420extending to line 310. Where menu switch 22 is again actuated, theprogram reverts to block 412 as represented at line 422.

Looking again to FIG. 12B and the query posed at block 362, where thesecond maximum grip test is not selected but menu switch 22 is actuated,then as represented at line 424 and block 426 the program enters a modefor restarting the maximum grip test. By again actuating menu switch 22,as represented at line 428 and block 430 the user is prompted to enterthe previous menu position in the program by actuating the select switch24. Accordingly, by actuating switch 24 as represented at line 432, theprogram reverts to node C. Returning to block 426, where the selectswitch 24 is actuated, then the program loops as represented at line434, to line 346 to again undertake the second of the maximum griptests. By actuating menu switch 22 from the program location of block430, as represented at line 436 the program reverts to its position atblock 426.

The diagnostic performance mode of the instrument 10 also provides forthe carrying out of a rapid exchange (RE) test. With the rapid exchangetest, the user may grip instrument 10 in the manner shown in FIG. 2 suchthat the therapist or practitioner may observe readout 18 to theexclusion of the user or patient. With the rapid exchange, a maximumgrip force is exerted by the user or patient in exchanging between theright and left hands under a controlled exchange timed cycle which willhave been elected, for example, in connection with the configurationmode described in connection with FIG. 11. It may be recalled that thenumber of exchanges may also be elected by the diagnostician as 10 or 20efforts or trials. The rapid exchange mode of performance is elected asrepresented at block 312 and line 318 extending to node B described inconnection with FIG. 12A. Node B reappears in FIG. 13 in associationwith line 440 and block 442. Referring to that figure, block 442 is seento provide for a prompt to the practitioner to actuate select switch 24to enter the rapid exchange mode. Upon actuating switch 24, asrepresented at line 444 and block 446 a prompt is provided at readoutassembly 18 advising the user to squeeze the grip 14 with the right handto start the rapid exchange sequence. As represented at line 448 andblock 450 the program awaits the presence of a right hand squeezingforce. Until that squeezing force is asserted, the program dwells asrepresented at loop 452 extending to line 444. Where a squeezing forceis detected, then as represented at line 454 and block 456 the programcommences to time out the succession of periods or time-hacks allocatedfor this cycle of the rapid exchange diagnostic procedure. That timeinterval may have been elected in the configuration mode as described inconjunction with blocks 286 and 290 (FIG. 11). For example, the cycletime, T_(r) has a default value of 1.5 seconds or the last valueselected.

As represented at line 458 and block 460 the user will have squeezed thegrip region 14 and the maximum hand force value evolved will besubmitted to memory. Then as represented at line 462 and block 464 adetermination is made as to whether the menu switch 22 has beenactuated. In the event that it has not, as represented at line 466 andblock 468 the program determines whether the Nth, i.e., 10^(th) or20^(th) trial has been completed. In the event that it has not, then asrepresented at line 470 and block 472 the rapid exchange test has notbeen completed and an audible tone cue (time hack) is providedindicating that the instrument should be switched to the opposite hand.A short dwell occurs as represented at line 474 and block 476 whereinthe instrument determines whether or not a squeeze force has beenasserted. In the event that it has not, then the program loops asrepresented at line 478. Where the user has imparted a squeezing forceto the instrument, the program continues or loops as represented at line480 extending to line 458 leading to a next trial in an alternate hand.

Returning to block 464 where menu switch 22 is actuated in the course ofcarrying out rapid exchange trials, an affirmative determination will bemade with respect to the query posed at that block. Accordingly, asrepresented at line 482 and block 484 the user is prompted to restartthe rapid exchange test by actuating select switch 24. Where selectswitch 24 is actuated, then as represented at line 486 the programreverts to line 444 and block 446. On the other hand, where menu switch22 is actuated, then as represented at line 488 and block 490 the useris prompted to revert to the previous menu by actuating select switch24. Where select switch 24 is so actuated, then the program reverts tonode C as represented at line 492. Note, additionally, that if menuswitch 22 is actuated in conjunction with the prompt provided at block442, then as represented at line 494 the program reverts to line 488.Returning to block 490, where menu switch 22 is actuated then asrepresented at line 496 and block 498 the program computes and displaysthe overall average of the maximum trial values, standard deviation andcoefficient of variation for the N trials. That data is submitted tomemory. Should menu switch 22 be actuated at this juncture, then asrepresented at lines 500 and 482, the program returns to block 484.Where the select switch 24 is actuated, however, as represented at line502 and block 504 the maximum force value for trial N and the average SDand CD for all trials is displayed. On the other hand, where the menuswitch 22 is actuated, then as represented at lines 506 and 482, theprogram reverts to block 484.

Where the select switch 24 is actuated repetitively, then as representedat line 508 and block 510 the succession of trials 1 through N isdisplayed. Additionally, the unchanging average for all those trials isdisplayed for convenience. Further, a query is posed as to whether theNth trial has been displayed. Where it has not, then the display programloops as represented at line 512 extending to line 502. On the otherhand, where the Nth trial has been displayed, then as represented atline 514, the program loops to line 502 to repeat the succession ofdisplays.

It may be recalled that in conjunction with block 398 in FIG. 12A, atherapy mode may be entered by actuation of select switch 24 asdiscussed in connection with line 408 and node E. Node E reappears inFIG. 14A in conjunction with line 520 and block 522. Block 522 indicatesthat the readout 18 will publish information that a grip therapy isavailable by actuation of select switch 24. It may be recalled that theparameters of time and force are somewhat pre-established under theregimen of the instant program. In this regard, it is important that theisometric grip exercise be constrained within predefined force and timeinterval of holding and resting limits. These parameters are nominatedin the program and while some variations are permitted, those variationsare retained within physiologically determined limit values. Ofimportance of the grip therapy at hand, it may be observed that it ispredicated upon the patient or users actual and unique the maximumgripping force which initially is evaluated and then treated by apreordained but still electable target valuation. In general, the promptand cues provided at display 18 are made available to the patient oruser by a handle configuration as described in conjunction with FIG. 1.Looking to FIG. 14A, block 522 provides for a display at readout 18indicating that a grip therapy mode is available by actuation of selectswitch 24. As represented at line 524 and block 526 a determination ismade as to whether a fixed mode of therapy or a stepped mode of therapyis to be elected. A fixed therapy is elected by actuation of selectswitch 24 as represented at line 527 extending to block 528. Block 528indicates that the fixed exercise configuration mode has entered. Withsuch entry, as represented at line 530 and block 532 readout 18 promptsthat the user will be given opportunities to adjust the target loadfactor, the number of repetitions of trials of the grip therapy, theduration of the holding of the grip force at a target value and theinterval for a intergripping rest. However, as an initial component ofthe procedure, the maximum grip force value for a given patient isdetermined. Accordingly, upon actuating switch 24 as represented at line534 and block 536 the user is prompted to squeeze the grip with maximumforce by publishing the terms: “squeeze hard!!!”. Then, as representedat line 538 and block 540, the squeeze generated load or force value isoutputted to the microprocessor 180 (FIG. 10). The maximum valuation ofthis initial force evaluation then is displayed at readout 18 asrepresented at line 542 and block 544. In the latter block, it may beobserved that a sample force valuation of 90.3 pounds is published atreadout 18. The user can elect that valuation as the maximum force valueto be used in the program by actuating select switch 24 as representedat line 546 and block 548. However, a prompt at readout 18 also providesthat the user may retry this maximum grip force evaluation asrepresented at loop line 550 extending to line 538. Where the user ortherapist determines that an appropriate grip force has been derived,then as represented at line 552 and block 554 the elected maximum forcevalue is submitted to memory and the program continues as represented atline 556 and block 558. Employing the elected maximum squeeze force, theprogram computes a target grip force using a default factor of 50%.Additionally, the program establishes a trial repetition number at adefault number of 4; a hold on target force interval of 45 seconds; anda default rest interval of 120 seconds. As represented at line 560 andblock 562 the computed target level then is displayed at readout 18along with the value of the elected maximum grip force and the defaulttarget factor of 50%. The terms “Target 45lb” blink as a prompt that thefactor can be altered within an established range. The user orpractitioner then is given the opportunity to adjust the target factorpercentage in 10% increments from 10% to 100% as represented at line 564and block 566 by actuating the menu switch 22. Next, as represented atline 568 and block 570 the program computes at a new target value basedupon the elected factor, an arbitrary designation “AA” being shown. Alower enabling grip force threshold also is derived. Should the userelect a target factor other than the 50% value by adjustment inconnection with block 566, the program will automatically nominate holdon target intervals and rest intervals for each available 10% selectionfrom within the range from 10% to 100% which the user may have elected.This, again, is for the purpose of protecting the user from excessiveeffort intervals and inadequate rest intervals. However, still withinthe mandated overall ranges, the user or therapist can change thosevalues for the hold on target effort and rest effort. The nominated holdor “Effort” and rest intervals contained in the program are summarizedin Table 1 below. TABLE 1 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% MaxMax Max Max Max Max Max Max Max Max 120 120 90 60 45 15 12 10 5 3 sec.sec. sec. sec. sec. sec. sec. sec. sec. sec. Effort Effort Effort EffortEffort Effort Effort Effort Effort Effort 60 120 120 120 120 120 120 6060 60 sec sec sec sec sec sec sec sec sec sec Rest Rest Rest Rest RestRest Rest Rest Rest RestFollowing the target load computation, as represented at line 572 andblock 573 the program displays the newly computed target force value atreadout 18 along with the default values for number of repetitions(which defaults at 4), and the nominated hold on target interval and therest interval (Table 1). As a prompt, the readout “4 REP” blinks toindicate that adjustment is available to the user. The program thencontinues as represented at line 574 which reappears in FIG. 14Bextending to block 576 which provides for adjusting the number ofrepetitions between the values 1 and 10 by actuating menu switch 22.Note that the maximum number of repetitions made available to the useris 10. The program then continues by actuating switch 24 as representedat line 578 and block 580 indicating that the computed target forcelevel (AA) and the newly elected repetition number herein represented as“B” is provided at the display along with the nominated values for holdon target interval (CCC) and rest interval (DDD). In this display, theterms: “CCC HOLD” blink to prompt the user to make any desiredadjustments within the mandated limits of from 5 seconds to 120 seconds.Accordingly, as represented at line 582 and block 584 the user orpractitioner may adjust the hold on target interval by actuating menuswitch 22. When the desired hold on target interval has been displayedat readout 18, the select switch 24 is actuated and the programprogresses as represented at line 586 and block 588 to provide a displayat readout 18 which indicates the computed target force level AA; theelected repetition number (B) and the elected hold on target interval(CCC). The display also will blink the terms “DDD REST” to prompt theuser to adjust the rest interval to a desired value within the mandatedinterval range of 10 seconds to 120 seconds. Accordingly, as representedat line 590 and block 592 the user or practitioner can adjust (by decadecomponents) the extent of the rest interval by actuating menu switch 22until a desired interval value is displayed. Once the desired intervalis so displayed, an actuation of select switch 24 will enter it intomemory. Next, as represented at line 594 and block 596 the programdisplays the now elected values including the target force (AAlb);repetitions (B REP); the hold on target interval (CCC); and the restinterval (DDD). The program then provides a prompt to the user to startthe therapy by actuating the select switch 24 as represented at line 598and block 600. Upon such actuation of switch 24, as represented at line602 and block 604 the program prompts the user at readout 18 to apply agripping force at the target level along with the further prompt“squeeze”. Next, as represented at line 606 and block 608 the programdetermines whether the grip force applied by the user is within 10% ofthe computed target force value (AA). This is the lower thresholddetermination as described in conjunction with block 570. In the eventthat the applied gripping force is not within 10% of the computed targetvalue, the program loops as represented at line 610 extending to block604 providing for a continuation of the prompt to hold on target. Wherethe applied grip force is within 10% of the computed target force value,then as represented at line 612 and block 614 the program commences totime out the hold on target interval previously elected or nominated(CCC) as discussed in connection with block 584. While this hold ontarget force interval is underway, as represented at line 616 and block618 a dynamic comparison value computation is carried out over asequence of short time components within the hold time out interval.That comparison value is utilized in driving a bar graph form of displayfunctioning to cue the user as to a proper grip force level. During thishold interval, as represented at line 620 and block 622 the program alsocompares the applied grip force with a force upper limit which iscomputed as 125% of the target force. In the event that the applied gripforce is above that upper limit, then as represented at line 624 andblock 626 an audible cue is sounded to warn the user that excessiveforce is being applied which is outside the proper protocol for thetherapy. The program then continues as represented at lines 628 and 630whereupon as set forth at block 632 a score as a percentage of targetvalue is computed for a sequence of time increments. This score may beutilized by the user and the therapist for purposes of evaluating thequality of the exercise regimen carried out by the user.

Turning momentarily to FIG. 15, a routine is depicted functioning tocarry out the computation and display of the noted score values. Thisroutine is entered into as represented at node 634 identifying it as adisplay of the score value. The routine commences as represented at line636 and block 638 indicating that the currently applied grip force orload value is read as the user attempts to match the target force value.Then, as represented at line 640 and block 642, the score is determinedby dividing that read force by the pre-computed target force andmultiplying the result by 100 to provide the score as a percent. Thisscore is developed for sequential increments of time, preferably eachincrement representing 1% of the hold on target interval (CCC). Asrepresented at line 644 and block 646, the score is converted into threedisplay characters. Then, as represented at line 648 and block 650,three characters representing the score are sent to readout 18 fordisplay. The score may be above or below 100%, 100% representing an ontarget grip force.

Returning to FIG. 14B, the program continues as represented at line 652which reappears in FIG. 14C extending to block 654. Block 654 indicatesthat a display is provided at readout 18 which cues the user as toessentially instantaneous score value, the time remaining for holding ontarget and further cues the user as to the level of grip force beingapplied with respect to target through the utilization of a centerpointer visual cue representing the target load value and an effortdynamic bar graph visual cue having a top position present as a bargraph top line. That top line will be aligned with the center pointerwhen the load value at output represents a force equal to the targetload value. The top line will move away from the center pointer when theload value output or grip force exerted by the user represents a forcewhich deviates from the target load value.

Looking momentarily to FIGS. 16A-16E, a representation of the display soprovided for differing grip force activity is set forth. In FIG. 16A,the dynamic bar graph extends to the right of the center pointerindicating a grip force which is too low. This lower grip force also isindicated by the lower score value of 62%. The display also includes anindication of the time remaining for the hold on target interval, forexample, 100 seconds. FIG. 16B also indicates through the dynamic bargraph that the asserted grip force is still too low but improved overthat shown in FIG. 16A as indicated by the shorter extent of the dynamicbar graph to the right of the center pointer and a higher score value of75%. FIG. 16C shows a cue wherein the user grip force is at the targetforce, the top line of the bar graph being aligned with the centerpointer and a score of 100% being displayed. Additionally, as before,the time remaining for the hold on target interval is displayed. FIG.16D shows that an excessive grip force is being applied by the user, thedynamic bar graph extending to the left of the center pointer. Thisexcessive force also is indicated by a score value of 125%. Timeremaining in seconds within the hold on target interval also isdisplayed. Finally, FIG. 16E shows a still more excessive application ofgrip force on the part of the user, the dynamic bar graph top lineextending well to the left of the center pointer and a score of 137%being represented. As before, time remaining in the “on target interval”is also displayed.

Returning to FIG. 14C the program is seen to continue as represented atline 656 and block 658 wherein a query is made as to whether the hold ontarget interval has timed out. In the event that it has not, then theprogram dwells as represented by loop line 660 extending to node I whichreappears in FIG. 14B with line 662 extending to line 620. In the eventof an affirmative determination with respect to the query posed at block658, then as represented at line 662 and block 664 an audible cue isgenerated at the annunciator 198 (FIG. 10). With the generation of thisaudible cue, then as represented at line 666 and block 668 the restinterval commences to be timed out. It may be recalled that the restinterval was elected in conjunction with block 592 (FIG. 14B). Duringthis rest interval, as represented at line 670 and block 672 the programwill provide a display at readout 18 which indicates the number oftrials or efforts remaining in conjunction with the elected repetitionvalue. At the termination of the first trial, that value will be B−1.The display also provides the average value of score and the interval oftime remaining in the rest interval. Next, as represented at line 674and block 676 a query is made as to whether the rest interval has timedout. In the event that it has not, then the program dwells asrepresented at loop line 678. Where the query posed at block 676 resultsin an affirmative determination, then as represented at line 680 andblock 682 an audible cue is generated and the program continues asrepresented at line 684 and block 686 providing for a reiteration of thetrial sequence. As represented at line 688 and block 690 a query is madeas to whether the elected number of repetitions of the trial (B) hasbeen accomplished. In the event that that elected number of repetitionshas not been completed, then the program dwells as represented at line692. In the event of an affirmative determination with respect to thequery posed at block 690, then as represented at line 694 and block 696a final or average score is computed and submitted to archival memory inconjunction with calendar and force data. In the latter regard, each ofthe average grip force values asserted by the user for each trial arerecorded. Next, as represented at line 698 and block 700 the programdetermines or selects an appropriate message of congratulation orwarning base upon the computed final score. The program then continuesas represented at lines 702 and block 704 to publish the selectedmessage at readout 18 and continues as represented at line 706 to nodeG.

Node G reappears in conjunction with line 708 (FIG. 14A) and block 526.Where the user or therapist has determined to cause instrument 10 toenter into a stepped therapy mode, menu switch 22 is actuated asrepresented at line 710 and the program displays a prompt to the user asrepresented at block 712 indicating that the step therapy mode may beentered by actuating select switch 24 as represented at line 714 andnode F.

Referring to FIG. 17A, node F reappears in conjunction with line 716 andblock 718 providing for the entry of instrument 10 into a steppedexercise configuration mode. In this therapeutic mode the maximum gripstrength unique to the user or patient is determined, whereupon thetherapeutic gripping regime is one wherein the target load level as wellas hold on target intervals and rest intervals vary in accordance thesequence of steps or gripping trials. The program opens as representedat line 720 and block 722 with a display at readout 18 prompting thatthe user is to be called upon to establish a maximum grip force leveland carry out a setting of the number of steps and repetitions of thetherapy. The user then actuates the select switch 24 and, as representedat line 724 and block 726 the program displays a prompt at readout 18indicating that the user should carry out a maximum grip force exercise,the prompt including the terms; “squeeze hard!!!”. Then, as representedat line 728 and block 730 the user will have applied maximum squeezingforce to the grip and that will have generated a load value output.While this load value output is being generated, as represented at line732 and block 734 the program displays a cue at readout 18 whichpublishes the value of the maximum gripping force. Should thepractitioner or user wish to attempt to improve that value, he or she isprompted to actuate select switch 24 and elect the value published or tosqueeze the grip again. Where the user elects the value published, thenas represented at line 736 and block 738 a determination is made as towhether the select switch 24 has been actuated. In the event that it hasnot, then the system dwells as represented at loop line 740 extendingline 728. Where the select switch 24 has been actuated, then asrepresented at line 742 and block 744 the maximum gripping force valuewhich was selected is submitted to memory and, as represented at line746 and block 748 the system provides a 1 step default value and arepetition of the step exercise is defaulted to a value of four. Theprogram then continues as represented at line 750 wherein the systemprovides a prompt at readout 18 which displays the value of a selectedmaximum gripping force and further prompts the user that a default of 1step is present and a default of four repetitions is present. The term“1 step” is intermittent or blinks as a part of this prompt to the userto elect the number of steps desired. This display is represented atblock 752. Then, as represented at lines 754 and block 756 the user orpractitioner is permitted to adjust the number of steps within a rangeof 1 to 5 steps. As discussed above, this range is mandated within thesystem and the adjustment in the number of steps may be carried out byactuating menu switch 22.

The number of steps elected adjusts the percentage of maximum grip forcefactor in accordance with a preordained schedule. That schedule isprovided in Table 2 below. For example, if only one step is elected,that target grip factor will be 20%. On the other hand if five steps areelected, the first trial will be at 100% of maximum grip force. Thesecond step will be at 80% of maximum grip force and so forth. On theother hand, if four steps are elected, the initial trial will be inconjunction with an 80% maximum grip force factor; the second step willbe at 60% and so forth as set forth in Table 2. For each of thesepercentages as set forth in Table 2, the corresponding hold on target oreffort interval and rest intervals will follow the values given above inTable 1. TABLE 2 No. of Steps Elected 1 2 3 4 5 1^(st) Step as % Max 20%40% 60% 80% 100%  2^(nd) Step as % Max 20% 40% 60% 80% 3^(rd) Step as %Max 20% 40% 60% 4^(th) Step as % Max 20% 40% 5^(th) Step as % Max 20%

The step value is elected by actuation of select switch 24 and theprogram continues as represented at line 758 and block 760. Block 760replicates a display at readout 18 which prompts the user by indicatingthat the maximum elected gripping force selected was 90 pounds and thatA steps were selected and a further prompt is provided showing blinkingor intermittent display of “4 REPS”. Then, as represented at line 762and block 764 the operator may adjust the number of repetitions of theprogram to a value within a preordained number of 1 through 10 byactuating menu switch 22. The elected number of repetitions then isselected by actuation of switch 24 and, as represented at line 766 andblock 768 the system displays the now selected parameters of a maximumgrip force, for example, 90 pounds, an election of A steps in theregimen and an election of “B” repetitions. Next, as represented at line770 and block 772 the stepped exercise therapy is entered. Upon entryinto this stepped exercise trial mode, target values are computed basedupon the number of steps elected and the hold on target and restintervals will be acquired, such data with respect to target factorsbeing set forth in Table 2 and the latter hold on target and restintervals being set forth in Table 1. This function is represented inblock 776. Line 778 reappears in FIG. 17B extending to block 780 whichprompts the user with a display indicating that to start the steptherapy the select switch 24 should be actuated. The operator may returnthe system to a previous menu at this juncture by actuating menu switch22. In this regard, as represented at line 782 and block 784 byactuating switch 22, the program will again display that initiallyelected maximum 90 pound grip force along with the prompt to squeezeagain or press select as represented at line 785 and node K. Thisreturns the program to block 752 (FIG. 17A) where node K reappears atline 750. While again actuating switch 22, as represented at line 786and block 788 a restarting of the step therapy test prompt is providedadvising the user to actuate switch 24. Again where switch 22 isactuated, then as represented at line 790 and block 792 the user isprovided a prompt display at readout 18 advising that the previous menumay be elected by actuating select switch 24. Where that switch isactuated, then as represented at line 794 and node H the program returnsto block 712 as earlier described in connection with FIG. 14A. In thisregard, node H reappears in that figure in conjunction with line 796extending to block 712. Where menu switch 22 is actuated the programloops as represented at line 795 extending to line 782.

Returning to block 780, where switch 24 has been actuated, then asrepresented at line 798 and block 800 the user is prompted to hold thegrip force at the computed target level for 100%. Additionally, theprompt tern “SQUEEZE” is provided within the readout 18. Next, asrepresented at line 802 and block 804 a determination is made as towhether the grip force exerted by the user is within 10% of the computedtarget value. Where it is not, then the system dwells as represented atloop line 806 and the display represented at block 800 continues. Wherethe asserted grip force is within 10% of the target load, then asrepresented at line 808 and block 810 the mandated hold on targetinterval timeout set forth in Table 1 commences and, as represented atline 812 and block 814 a dynamic comparison value is derived for dynamicbar graph cueing. Next, as represented at line 814 and block 816 acomputation then is made as to whether the instantaneous grip force isat or above 125% of the target value. Where that is the case, then asrepresented at line 820 and block 822 an audible warning cue is sounded.The program then continues as represented at lines 824 and 826 when theexcessive force has been lessened. Line 826 is directed to block 828which provides for carrying out a computation of a score value as apercentage of target for a sequence of time increments. Computation ofthis score has been discussed in connection with FIG. 15. The programthen continues as represented at line 830.

Line 830 reappears in FIG. 17C extending to block 832 which provides adisplay at readout 18 with essentially instantaneous score values, thenoted dynamic bar graph and hold time remaining for the initial step athand. The dynamic bar graph has been described in conjunction with FIGS.16A-16E. Next, as represented at line 834 and block 836 a query is posedas to whether the hold time interval has expired. Where it has not, thenthe system dwells as represented at loop line 838 extending to node J.Node J reappears in FIG. 17B in conjunction with line 840 extending toline 816. However, where the hold on target interval has expired, thenas represented at line 842 and block 844 an audible cue is generatedand, as represented at line 846 and block 848 a Table 1 mandated restinterval is commenced. The program then continues as represented at line850 and block 852 wherein the system cues the user that (A×B)−1 effortsremain out of the previously selected (A×B) efforts and further advisesof the time remaining for the rest interval and the current score value.With this display, the system queries as to whether the rest intervalhas expired as represented at line 854 and block 856. Where the resttime remains at hand, then the system dwells as represented at loop line858 extending the line 850. However, where the rest interval hasexpired, then as represented at line 860 and block 862 an audible cue isgenerated.

Following the generation of this audible cue, as represented at line 870and block 872 the program reiterates the trial sequence following themandates of Tables 1 and 2 and the elected parameters. As represented atline 874 and block 876, a query then is made as to whether therepetitions and associated efforts are complete. This value is theproduct of the elected number of steps A multiplied by the electednumber of repetitions, B. Where that number of reiterations has notoccurred, then the program continues as represented by loop line 878extending to line 870. Where the number of repetitions is completed,then as represented at line 880 and block 882 a final score is computedand submitted to memory with calendar and force data. Next, asrepresented at line 884 and block 886 the program selects a message tothe user which will be based upon the final score. For example, the usermay be advised to consult a therapist or the program directions in theevent of a low score and is congratulated in the event of a good score.As represented at line 888 and block 890 those messages are selected.Where the user actuates select switch 24, the program continues asrepresented at line 892 and node H.

Turning again to FIG. 14A, node H reappears in conjunction with line 796leading to the block 712 displaying a prompt that, to cause the programto enter the stepped therapy mode, the select switch 24 should beactuated. However, where menu switch 22 is actuated, then as representedat line 896 and block 898 the program displays a prompt that to enterthe previous menu, the select switch 24 should be actuated. Where thatselect switch is so actuated, then as represented at line 900, theprogram reverts to node E which reappears in the instant figure inconjunction with line 520 extending to block 522. On the other hand,where the user actuates menu switch 22, then as represented at line 902the program reverts to node G. Node G is shown in the instant figure inconjunction with line 708 extending to block 526.

The user has the option of powering down instrument 10 by pressingselect switch 24 for an interval of at least 2 seconds. This power offsequence is represented in the flow chart of FIG. 18. The sequence openswith node 910 and line 912 extending to block 914. Block 914 indicatesthat select switch 24 is being actuated and held in an actuated state.During this actuated state, as represented at line 916 and block 918 adetermination is made as to whether the 2 second interval has elapsed.If it has not, then as represented at line 920 and block 922 a query isposed as to whether the select switch 24 has been released before thetermination of 2 seconds. If it has not, the system dwells asrepresented at loop line 924 extending to line 916. Where the query atblock 918 results in an affirmative determination, then as representedat line 926 and block 928 the instrument 10 is powered down. Where thedetermination at block 922 indicates that the switch 24 has beenreleased prior to the elapsing of 2 seconds, then as represented at line930 and block 932 the program reverts to the previous or last displaywhich was published at readout 18.

The protocol based isometric exercise approach of the invention hasapplicability to a broad range of muscle groups of the user. Byemploying the protocol which, inter alia, involves the evaluation ofmaximum muscle group strength as a precondition to then applying afactor related protocol, one of those factors may apply to the measuredmaximum strength value. The remaining factors which involve, forexample, variations of target loads, hold times, rest intervals andexercise regimen planning in terms of calendar days achieves a safe andeffective utilization of isometric activities. The exercisableanatomical features to be strengthened are generally identifiable asmuscle groups of the human anatomy which may include but are not limitedto: jaw muscles, neck muscles, shoulder muscles, upper arm muscles,lower arm muscles, hand muscles, finger muscles, diaphragm muscles,abdominal muscles, lower back muscles, upper leg muscles, lower legmuscles, ankle muscles, foot muscles, and toe muscles.

Looking to FIG. 19, a flow diagram is presented which outlines themethodology achieving this safe utilization of isometric exercises. Inthe figure, block 950 reveals that the user or therapist may establish agoal of strength for the muscle group involved. This may be achieved bymeasuring the maximum strength of an unimpaired contralateral musclegroup. For example, a left arm or upper leg muscle group may be testedto determine a strength goal for a right arm or right upper leg muscle.Where no unimpaired contralateral muscle group is available to set thisgoal strength, a medical professional will establish an appropriate goalstrength. The method continues as represented at line 952 of block 954providing for the measurement of maximum strength of the specificanatomical feature to be treated. As represented at line 956 and block958, the methodology identifies a protocol matrix of factors. In thisregard, a strengthening protocol is derived which is based upon timedefforts which are equal to a percentage of the measured maximum strengthas derived in connection with block 954. The matrix of factors furtherinclude hold times at a factor or factors of the measured maximumstrength, the repetition of these efforts for a given trial or exercisesession and the duration of rest periods where repetitions are involved.Such protocol further will indicate the intervals of repetitions of theexercise sessions themselves during a stated period of time in hours,days, weeks, months and the like. This matrix of factors may becontained, for example, in computer memory. Looking to line 960 andblock 962, the procedure next nominates values to the factors providedin conjunction with block 958. In this regard, the strengtheningprotocol which is developed utilizes nominated factors from the matrixof these exercise factors. In effect, the nominated factors may beidentified as “effort” applied by the specific anatomical feature andthe effort time period during which the effort is to be applied suchthat there is a relationship among the percentage of the measuredmaximum strength of time wherein the higher the percentage, the shorterthe effort time and the number of repetitions of these efforts during anexercise session, the rest period time between cessation of one effortand the beginning of the next succeeding effort such that there is arelationship between the percentage of the measured maximum strength andthe rest time wherein the higher the percentage the longer the rest timeand the number of exercise sessions in a given time period (hours, days,weeks, months). As represented at line 964 and block 966, the procedureinitiates and monitors the exercise protocol with nominated factors. Inthis regard, the procedure monitors and guides the exercise effort to beapplied and while being applied, provides visual and/or audible cues toencourage compliance to the elected protocol using symbols as the visualcues and words which clearly guide the effort to be applied. While thateffort is being applied, using audible cues and words which assist toproperly perform the effort, rest periods and repetitions for eachexercise session. Looking to line 968 of block 970, the method providesfor annunciating an alarm when an exercise effort level is exceeded. Inthis regard, an audible alarm is produced if the exercise effort exceedsa predetermined or factor determined level beyond which it is consideredthat the exercise effort could be damaging to the human physiology orthe specific anatomical feature at hand. As represented at line 972 andblock 974 the method provides compliance scores in real-time and insummation during the course of an exercise effort and subsequentthereto. As described herein, the program calculates a compliance scoreduring each exercise effort in percent of that effort required in thestrengthening protocol and provides this compliance score in real-timeas the effort is being accomplished on the specific anatomical feature.An averaging of this compliance score over each exercise effort timeperiod is devised to depict the degree to which the exercise effortapplied has been accomplished. By accumulating the compliance scoresduring each rest period and then presenting a final compliance scoreissued in the form of both a number as a percent accomplished and in aninstruction set an indication is derived as to how well the exerciseprotocol was performed or how to improve future compliance. Next, asrepresented at line 976 at block 978 the exercise data is archived forreview and potential transfer to a remote interactive entity. This stepin the procedure accumulates real-time and summary data for each effortor trial and the specific protocol being utilized. It may be noted thatthese protocols are selected each time the exercisable anatomicalfeature is elected to be strengthened such that the elected protocol,the effort being applied and the compliance being calculated during andat the conclusion of each effort may be reviewed remotely as it is beingaccomplished using suitable data communication assistance and at theconclusion of each effort. The archive data is time-stamped and uniquelyidentified for retrieval.

Since certain changes may be made in the above-described apparatus,method and system without departing from the scope of the inventionherein involved, it is intended that all matter contained in thedescription thereof or shown in the accompanying drawings shall beinterpreted as illustrative and not in a limiting sense.

1-77. (canceled)
 78. Apparatus for carrying out a protocol-basedisometric exercise regimen, comprising: a rigid housing having a handgrasping portion with first and second base grip components havingrespective outwardly disposed first and second elongate graspingsurfaces, said first and second grip surfaces being spaced apart a firstpredetermined widthwise extend and said first base grip having a firstbase connector assembly adjacent the said first grip surface thereof,said housing having an interacting portion fixed to and extending fromsaid hand grasping portion; an elongate rigid thrust plate positionedwithin said housing hand grasping portion in force transfer relationshipwith said first and second base grip components; a load cell assemblycoupled in stress transfer relationship with said thrust plate andhaving a force output signal in response to stress imposed from saidfirst and second base grip components; a control circuit within saidhousing responsive to said force output signal to provide an evaluationoutput; a readout assembly mounted at said housing interaction portion,responsive to said evaluation output to provide a perceptible outputcorresponding therewith; and a first auxiliary grip component having afirst auxiliary grasping surface and a first auxiliary connectorassembly adjacent said first auxiliary grasping surface removablyconnectable with said first base connector assembly, when said firstauxiliary connector assembly is connected with said first base connectorassembly said first auxiliary grasping surface being spaced from saidsecond base grip second grasping surface a second predeterminedwidthwise extent greater than said first predetermined widthwise extent.79. The apparatus of claim 78 in which: said second base grip componentincludes a second base connector assembly adjacent the said secondelongate grasping surface thereof; and aid first auxiliary gripcomponent first auxiliary connector assembly is removably connectablewith said second base connector assembly, when said first auxiliaryconnector assembly is connected with said second base connector assemblysaid first auxiliary grasping surface being spaced from said first basegrip first grasping surface said second predetermined widthwise extent.80. The apparatus of claim 78 in which: said first auxiliary gripcomponent is generally semi-cylindrical in shape, and said firstauxiliary grasping surface is of an undulatory finger graspingconfiguration.
 81. The apparatus of claim 78 in which: said second basegrip component includes a second base connector assembly adjacent thesaid second elongate grasping surface thereof; and further comprising asecond auxiliary grip component having a second auxiliary graspingsurface and a second auxiliary connector assembly adjacent said secondauxiliary grasping surface removably connectable with said first baseconnector assembly as said second base connector assembly, when saidsecond auxiliary connector assembly is connected with said first orsecond base connector assembly said second auxiliary grasping surfacebeing spaced from respective said second or first grip surface saidsecond predetermined widthwise extent.
 82. The apparatus of claim 81 inwhich: said second auxiliary grip component is generallysemi-cylindrical in shape, and said second auxiliary grasping surface isgenerally of concave curvature effective to engage the palm of the hand.83. The apparatus of claim 78 in which: said second base grip componentincludes a second base connector assembly adjacent the said secondelongate grasping surface thereof; further comprising a second auxiliarygrip component having a second auxiliary grasping surface and a secondauxiliary connector assembly adjacent said second auxiliary graspingsurface removably connectable with said first base connector assembly;said first auxiliary grip component first auxiliary connector assemblyis removably connectable with said second base connector assembly; andwhen said first auxiliary connector assembly is connected with saidsecond base connector assembly and said second auxiliary connectorassembly is connected with said first base connector assembly, saidsecond auxiliary grasping surface is spaced from said first auxiliarygrasping surface a third predetermined widthwise extent greater thansaid second predetermined widthwise extent.
 84. The apparatus of claim78 in which: said readout assembly is mounted at said housinginteraction portion in an angular orientation effective to be observedonly from an eye station having a line of sight confronting said firstbase grip component.
 85. A system for carrying out an isometric exerciseregimen by a user, comprising: a hand grip assembly including a loadcell component responsive to compressive squeezing force applied by ahand of said user to derive a load value output corresponding with thevalue of said force; a display, responsive to a visual input signal toprovide a visually perceptible display output; first and second controlmembers hand actuable to provide respective first and second controlconditions; a controller including a processor and memory operativelyassociated therewith; and said processor being responsive to said firstcontrol condition to conditionally enter a diagnostic grip test modeproviding a said visual input signal deriving a first prompt at saiddisplay to actuate said first control member to enter said diagnosticgrip test mode, is responsive to said second control condition to vconditionally enter a therapy mode, and is then responsive to said firstcontrol f condition to provide a said visual input signal deriving asecond prompt at said display to actuate said first control member toenter said therapy mode.
 86. The system of claim 85 in which: saidprocessor is responsive in the presence of said first prompt to saidfirst control condition to derive a said visual input signal providing athird prompt to said user at said display to actuate said first controlmember to enter a maximum grip test therapy mode.
 87. The system ofclaim 85 in which: said processor is responsive in the presence of saidfirst prompt to said second control condition to derive a said visualinput signal providing a fourth prompt at said display to actuate saidfirst control member to enter a rapid exchange diagnostic mode.
 88. Thesystem of claim 85 in which: said processor is responsive in thepresence said second prompt to said first control condition to derive asaid visual input signal providing a fifth prompt at said display toactuate said first control member to enter a fixed exercise therapymode.
 89. The system of claim 85 in which: said processor is responsivein the presence of said second prompt to said second control conditionto derive a said visual input signal providing a sixth prompt at saiddisplay to actuate said first control member to enter a stepped exercisetherapy mode. 90-93. (canceled)
 94. A method for carrying out anisometric exercising by a user, comprising the steps of: identifying amuscle group of said user for isometrically exercising; measuring themaximum isometric strength capability value of said identified musclegroup; identifying a protocol matrix of factors; nominating values tosaid factors; initiating and monitoring an exercise protocol based upona said factor, applied to said measured maximum strength to derive atarget force value and a factor representing a hold interval for saidtarget force; annunciating an alarm when said target force value isexceeded by said user during said exercise; compiling exercise data fromsaid exercise protocol; and archiving said exercise data.
 95. The methodof claim 94 further comprising the step: providing compliance scoresduring said exercise protocol.
 96. The method of claim 94 in which: saidmuscle group is identified from the group comprising: jaw muscles, neckmuscles, shoulder muscles, upper arm muscles, lower arm muscles, handmuscles, finger muscles, diaphragm muscles, abdominal muscles, lowerback muscles, upper leg muscles, lower leg muscles, ankle muscles, footmuscles, and toe muscles.
 97. The method of claim 94 further comprisingthe step of: establishing a goal strength of measuring the maximumstrength of an unimpaired muscle group contralateral to said identifiedmuscle group.